In this episode, Sam Ashoo, MD interviews Evan Dvorin, MD about the dangers of short term steroid use.
Background & Regional Differences
- Dr. Dvorin’s clinical journey from New England to New Orleans.
- Noticing increased use of corticosteroids for common conditions in the Southeast.
- Discussion of how steroid prescribing practices vary by region and setting.
Inappropriate Steroid Use
- Common conditions where steroids are often inappropriately prescribed (sinus infections, bronchitis, sciatica, rashes, plantar fasciitis, etc.).
- Trends showing increased steroid prescribing over time.
- Similar patterns observed in emergency, urgent care, and primary care settings.
Risks and Side Effects of Short-Term Steroid Use
- Short-term steroids can cause significant side effects: infection, sepsis, bone fractures, thromboembolism, psychiatric effects, hyperglycemia.
- Dose-response relationship: higher doses and repeated use increase risks.
- Some side effects (e.g., bone loss) may persist beyond two months.
Patient Communication & Shared Decision-Making
- Importance of discussing risks with patients, tailored to individual risk factors (e.g., diabetes, psychiatric history, age).
- Strategies for educating patients and managing expectations.
- The role of patient education videos and resources.
Impact of Provider Education & Quality Metrics
- Ochsner Health’s initiatives to reduce inappropriate steroid use.
- Use of CME, quality dashboards, and feedback to clinicians.
- Evidence that education and reporting can reduce unnecessary prescriptions.
Special Populations & Scenarios
- Considerations for pediatric patients and repeated dosing.
- Challenges when specialists recommend steroids for certain conditions (e.g., sciatica, neurosurgery cases).
- The need for evidence-based practice and inter-provider communication.
Medical-Legal Considerations
- Lawsuits related to steroid side effects (e.g., fat atrophy, infection).
- Importance of documentation and informed consent.
Alternatives & Symptom Management
- Focusing on treating the patient’s most bothersome symptoms.
- Non-steroid options and the value of patient education about illness duration and expectations.
Resources
- Mention of Dr. Dvorin’s educational video on corticosteroid side effects (available on YouTube).
- Reminder of EB Medicine’s journals and resources for further learning.
Conclusion
- Key takeaway: “Do no harm” and practice evidence-based medicine.
- Encouragement for clinicians to review their prescribing habits and educate patients.
Ochsner "Side effects from corticosteroids" Video: https://www.youtube.com/watch?v=PdMJ9HYxkck